There are no well-matched, controlled studies comparing azithromycin with doxycycline for the treatment of complicated scrub typhus. were not significantly different (89% [65/73 patients] versus 96% [70/73 patients] and 96% [70/73 patients] versus 96% [70/73 patients], respectively [> 0.05]). No difference was observed in the time to defervescence or length of hospital stay between the two groups (> 0.05). In complicated scrub typhus patients (= 181), multivariate analysis showed that only APACHE II score was an independent risk factor for mortality (95% confidence interval, 1.11 to 1 1.56; < 0.001). Our data suggest that outcomes of azithromycin therapy are comparable to those of doxycycline therapy in patients with complicated scrub typhus. INTRODUCTION Scrub typhus is usually a mite-borne rickettsiosis caused by antigen. A positive result was defined as a titer of 1 1:80 in a single serum sample or by a 4-fold increase in the follow-up titer (14). The PHA was performed using Genedia Tsutsu PHA II test kits (GreenCross SangA, Yongin, Republic of Korea). Patients with complicated scrub typhus who were treated with doxycycline (100 mg orally every 12 h) or azithromycin (500 mg intravenously every 24 h) were included. Each patient's medical record was reviewed for information regarding age, sex, underlying disease, symptoms, indicators, physical and laboratory findings at the time of admission, treatment, and outcome. Definitions. Complicated scrub typhus was defined by the following conditions (11, 12): (i) shock, defined by a systolic blood pressure of <90 mm Hg or a fall in systolic blood pressure of >40 mm Hg; (ii) acute kidney injury, defined by a serum creatinine increase of >2.0-fold or a glomerular filtration rate decrease of >50% from baseline; (iii) pneumonia with parenchymal lung lesions on a chest radiograph and cough or dyspnea; (iv) acute respiratory distress syndrome, defined by a ratio of arterial partial oxygen tension as a fraction of inspired oxygen of <200 mm Hg in the presence of bilateral infiltrates on a chest radiograph; (v) meningoencephalitis with neurologic symptoms and evidence of infection of the central nervous system, based on imaging studies or cerebrospinal fluid (CSF) counts of >5 leukocytes/mm3; (vi) gastrointestinal bleeding; and (vii) cholecystitis, defined by the presence of Murphy’s sign and radiological evidence of gallbladder inflammation. Mortality was defined as scrub typhus related if there was no other definite cause of death (15). Treatment was considered a failure when scrub typhus-related death occurred or if the initial antibiotic was changed to another agent(s) due to clinical deterioration, despite 5 days of antibiotic administration, without any other identifiable cause (7). Treatment was defined as successful if the agent used was not subsequently changed because of ineffectiveness and if Rabbit Polyclonal to DDX50 scrub typhus-related death did not occur. Statistical analysis. Our major analysis compared the treatment outcomes between the doxycycline- and azithromycin-treated groups with complicated scrub typhus. We used propensity score adjustment to control for the following confounding variables: age (11, 13), white blood cell count (11, 13), creatinine level (16), albumin level MDV3100 (11, 17), and acute physiology and chronic health evaluation II (APACHE II) score (18). These variables are reported risk factors for complicated scrub typhus. This technique permitted pair-matched selection of 73 of the 108 patients in the doxycycline-treated group MDV3100 who were most similar to the patients in the azithromycin-treated group. The Kolmogorov-Smirnov goodness-of-fit test was used to determine the distribution of each set of data for normality before subsequent analysis. Categorical variables were expressed as percentages of counts, and continuous variables were expressed as means standard deviations (SD) or as medians and interquartile ranges (IQR). Categorical variables were compared using the 2 2 test or Fisher’s exact test, as appropriate. Continuous variables were compared by the Student test or the Mann-Whitney U test, as appropriate. Kaplan-Meier survival analysis in association with the log rank test was performed to compare the time to defervescence between groups. Logistic regression analysis was MDV3100 carried out, with inclusion of variables with values of <0.10 in univariate analysis. All assessments of significance were two-tailed, and values of 0.05 were deemed to indicate statistical significance. Statistical analyses of the data were performed using SPSS v. 19.0 (SPSS, Chicago, IL). RESULTS Baseline characteristics of patients with complicated scrub typhus. A total of 771 patients were diagnosed with scrub typhus at our institute during the study period. Of these, 615 (79.8%) patients were admitted, and 217 (28.1%) had complicated scrub typhus at presentation. A total of 181.